What Are Medical Coding Audits and Why Do You Need One?

medical coding audits

In 2018, it was discovered that 80% of medical bills in the U.S. had a billing error. This mistake wound up costing patients a lot of money—averaging around $1,300.

Not only do medical coding errors have an impact on patients, but it can also cost your practice. If you continue to make mistakes, this can negatively impact your reputation and reduce patient trust.

While it’s not necessarily fun, conducting medical coding audits is essential.

Read on to find out exactly what this process is and why you need a medical coding audit.

What Are Medical Coding Audits?

When you conduct a medical coding audit, you will check your coding for accuracy and ensure that it complies with current policies and procedures. The goal is to ensure that your practice is running efficiently and to reduce liability issues.

It’s imperative in your practice and for healthcare as a whole to have coding auditing conducted. This process ensures that your records are accurate and complete. It has a direct impact on your practice’s livelihood and how well patients are being treated.

The Benefits of Conducting Regular Coding Audits for Your Medical Practice

No practice is perfect, so the chance of finding issues while working with a medical coding auditor is high.

The only way to improve your practice and ensure that your patients are being treated correctly is to know where you are making mistakes.

Here are some of the benefits that come from working with a medical coding auditor on a regular basis.

Stay in Compliance and Reduce Fraud

To ensure that you are getting paid on time from Medicare, insurance companies, and even your patients, you need to make sure you are using the right codes to create invoices that reflect the right prices for services rendered.

If you don’t, this can delay how quickly you get your money.

In addition, to reduce your chances of getting in trouble for fraud, you need to make sure that you aren’t adding any extra codes or billing for services that were unnecessary or weren’t provided.

When audit your medical coding, you can discover any incorrect billing practices. If your staff handles inputting this information, there’s a chance that human error could occur. Conducting an audit is the best way to find and correct this problem.

Should you find that fraud is being intentionally committed, you’ll be able to take the necessary steps before it winds up costing you your practice.

Increase Accuracy

The accuracy of medical coding has an impact on the quality of the reports you create and your risk adjustment.

Conducting regular audits allows you to determine if you are maintaining proper documentation. If you aren’t, this could lower your coding quality. Since coders need accurate and complete documentation to complete their job, this could be where the issues stem from.

Finding and fixing this problem means knowing that it exists, and it’s another reason why medical coding auditing is so important.

Provide Coders With the Proper Training

One of the most beneficial reasons why you should consider having your medical coding audited is because it can ensure that your staff has the proper training.

When you work with a medical coding auditor, they will have the most up-to-date information on the rules and regulations, as well as the latest codes. If you have them come in on a regular basis, your coding staff will acquire the necessary skills and abilities to code properly. This will keep your practice running optimally.

Protect Your Bottom Line

One of the other really important reasons why you should be conducting regular coding auditing is to protect your bottom line. Having inaccurate coding means your practice will lose money.

Losing money for your practice can occur in a couple of different ways.

The first is that if you have the wrong codes on the bill, the insurance company or Medicare may deny and/or reject the claim.

The codes may also go against the terms of the provider-payer contract. Whether done intentionally or accidentally, not getting what you are owned will hurt your practice.

While it’s possible to correct any coding issues and resubmit to the payer for payment, this takes time.

If you are undercharging for the services that were provided, this will also impact your bottom line.

Again, this could be due to human error and typing in the wrong code, or it could be due to changing your fees and not updating your codes to match the new prices.

Having an audit will be able to catch these issues and make sure that you are charging correctly and getting your payments on time.

Why You Should Consider an External Coding Audit

Medical coding audits can be conducted internally or you can have an external auditor come into your business.

Having an external auditor come in to conduct a medical coding audit has its benefits, and they include the following:

Completely Objectivity

External auditors don’t have a relationship with the coders or your practice. They can conduct an audit without being afraid that there will be repercussions for their findings.

They Are on Your Side

Auditors want to make sure your business is a success, so they will conduct an audit to keep you in compliance.

They will also make sure that your codes are current and correct so that you are getting paid quickly and the correct amounts.

They Can Find Things Others Might Have Missed

Having an external auditor come in to audit your medical coding is a great way to find things that your current employees might miss.

It’s easy to become compliant and assume that the way the coding is being done is the right way—if only because that’s the way it’s always been done.

An external auditor can find issues with the current template or problems within the system and propose ways to correct them.

Keep Your Practice Running Smoothly

Conducting medical coding audits is imperative if you want to ensure that your practice is in compliance with the current rules and regulations. This process also ensures you are getting paid in a timely fashion for the services you provided.

For more information on how to keep your practice compliant or for other information about how to improve your medical business, check out more articles from Market Business News.


Interesting related article: “What is an Audit?”